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Magnetic Resonance Imaging of Temporomandibular Joint and Aortic Root Score in Fibrillinopathies
Paloma Moisii1,2, Alexandru Gratian Naum3,4, Andra Mara Ursu5
11st Medical Department, "Gr.T.Popa" University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania.
Abstract:
Background and Objectives: Fibrillinopathies have different phenotypic expression: Marfan-like skeleton features, MLSF; mitral valve prolapse syndrome, MVPS; MASS phenotype, M = mitral valve prolapse, MVP, A = aortic root dilation, S = skeletal features, and the second S = (cutaneous) striae; Marfan Syndrome, MS. The study had the following main objectives: the correlation between disc displacement, DD (a major sign for temporomandibular joint dysfunction, TMDs) on magnetic resonance imaging, MRI, and aortic Z score (a major sign for aortic root dilation) on echocardiography; the predictive value of DD towards aortic Z score. DD had 2 types of severity: DD with reduction (the mild type, DDwR), and DD without reduction (the severe type, DDwoR). Materials and Methods: The type of fibrillinopathy was precised by clinical exam (systemic score), ophthalmic exam (for ectopia lentis), and echocardiography (aortic Z score, MVP). Medical treatment consisted of betablockers, BB (for patients with tachycardia), or angiotensin II receptor blockers, ARB. Surgical treatment was addressed to aortic root aneurysm, and severe mitral regurgitation, MR. DD benefited from dental conservatory treatment or surgical restoration. Results: DD-Z score had a powerful correlation in MASS (Rho = 0.787, p < 0.01), and in MS patients (Rho = 0.819, p < 0.01). For the entire sample, both DDwR-Z score and DDwoR-Z score had a moderate correlation (Rho = 0.469, and respectively 0.669). Furthermore, DD was an important predictor for Z score. DDwoR had a double power of prediction for the Z score compared with DDwR (B coefficient = 1.661 for DDwR and 3.281 for DDwoR). Conclusions: TMDs had a powerful correlation with aortic root dilation in MASS and MS patients from the sample. Likewise, TMDs was a major predictor for aortic root dilation, in the entire sample. In clinical practice, we can utilize an extracardiac finding, TMDs, obtained by a non-invasive technique, MRI, for cardiac severity stratification of fibrillinopathies.
Insights
Temporomandibular joint dysfunction (TMDs), indicated by disc displacement (DD) on MRI, strongly correlates with aortic root dilation in fibrillinopathies. TMDs serve as a key predictor for aortic severity, aiding in patient stratification.
Area of Science:
- Connects rheumatology, cardiology, and radiology through the study of fibrillinopathies.
- Investigates the link between extracardiac manifestations and cardiovascular complications in genetic connective tissue disorders.
Background:
- Fibrillinopathies encompass a spectrum of conditions including Marfan-like skeletal features (MLSF), mitral valve prolapse syndrome (MVPS), and Marfan Syndrome (MS).
- These disorders are characterized by diverse phenotypic expressions, primarily affecting the cardiovascular and skeletal systems.
- Temporomandibular joint dysfunction (TMDs), specifically disc displacement (DD), is a recognized extracardiac finding.
Purpose of the Study:
- To determine the correlation between temporomandibular joint disc displacement (DD) and aortic Z score in patients with fibrillinopathies.
- To evaluate the predictive value of DD severity (with reduction, DDwR; without reduction, DDwoR) for aortic root dilation.
- To explore the utility of TMDs as a non-invasive marker for cardiac severity stratification in fibrillinopathies.
Main Methods:
- Phenotypic characterization of fibrillinopathies through clinical (systemic score), ophthalmic (ectopia lentis), and echocardiographic (aortic Z score, MVP) examinations.
- Magnetic resonance imaging (MRI) was used to assess temporomandibular joint disc displacement (DD).
- Statistical analysis, including correlation (Rho) and regression (B coefficient), was performed to assess the relationship between DD and aortic Z score.
Main Results:
- A strong positive correlation was observed between DD and aortic Z score in patients with the MASS phenotype (Rho = 0.787) and Marfan Syndrome (Rho = 0.819).
- Moderate correlations were found for the entire sample between DDwR and aortic Z score (Rho = 0.469), and DDwoR and aortic Z score (Rho = 0.669).
- Disc displacement (DD) was a significant predictor of aortic Z score, with severe DD (DDwoR) showing double the predictive power compared to mild DD (DDwR).
Conclusions:
- Temporomandibular joint dysfunction (TMDs) demonstrates a powerful correlation with aortic root dilation in MASS and MS patients.
- TMDs, assessed via MRI, serves as a significant predictor for aortic root dilation across the entire sample of fibrillinopathy patients.
- Extracardiac findings like TMDs offer a valuable, non-invasive tool for stratifying cardiac severity in the clinical management of fibrillinopathies.
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